BEHAVIORALLY-CONTINGENT PHARMACOTHERAPY FOR OPIOID DEPENDENCE

针对阿片类药物依赖的行为相关药物治疗

• 批准号: 6338703
• 负责人: ROBERT K BROONER
• 金额: $ 38.51万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2000
• 资助国家: 美国
• 起止时间: 2000-07-01 至 2001-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6338703
• 关键词: behavior modification; behavioral /social science research tag; clinical research; clinical trials; combination therapy; community health services; comorbidity; counseling; drug abuse chemotherapy; drug addiction; group counseling; health services research tag; high risk behavior /lifestyle; human subject; human therapy evaluation; interview; methadylacetate; opiate alkaloid; outpatient care; psychopharmacology; psychosocial service; reinforcer; therapy compliance; urinalysis

An impressive number of studies have been conducted to improve the treatment response of patients receiving methadone substitution therapy. This work has become critically important because of the high rate of HIV transmission associated with drug abuse and the increasing number of patients responding poorly to standard methadone treatment. The trend toward poorer outcomes across methadone substitution programs parallels the epidemic of severe cocaine and other drug use problems in treatment seeking opioid abusers. Although studies now show that many forms of psychosocial treatments can enhance response to methadone pharmacotherapy, they also reveal limited interest and poor attendance when patients are offered these services. This problem illustrates the need for newer service delivery models that ensure participation in the psychosocial treatments necessary to maximize response to the pharmacotherapies. To be effective, these new models of treatment must also achieve success without doing harm to treatment retention. The approval of levo alpha acetyl methadol (LAAM) for opioid maintenance therapy raises yet another question that is important to evaluate- whether effective psychosocial treatments with one medication (i.e., methadone) will retain their efficacy across other pharmacotherapies. We previously demonstrated the effectiveness of a new treatment delivery model for opioid abusers that produced excellent clinical outcomes by making the continued availability of methadone ultimately contingent on counseling attendance and brief episodes of abstinence. In the proposed study, we will evaluate the efficacy of this treatment in a new group of opioid abusers inducted and maintained on LAAM, which has a very different clinical medication reporting schedule that might interact with the behavioral interventions driving out treatment approach. A total of 220 patients will be randomly assigned to our specialized treatment or a standard care comparison group and evaluated over a 10 month period, including a month baseline and a three month follow-up. Major outcome measures include rates of counseling attendance, self- reported and objectively measured drug use, rates of HIV risk behavior change, and treatment retention. The study will also provide information about the influence of individual differences (e.g., psychiatric co- morbidity, personality, stages of change) on response to LAAM substitution when it is administered either contingently with, or independently of, scheduled counseling services.

已经进行了令人印象深刻的研究以改善 接受美沙酮替代治疗的患者的治疗反应。 由于艾滋病毒率高，这项工作变得至关重要 与药物滥用相关的传播以及越来越多的 对标准美沙酮治疗的反应较差。趋势 在美沙酮替代方案之间取得较差的结果 严重可卡因和其他药物治疗问题的流行 寻求阿片类药物滥用者。 尽管研究现在表明，许多形式的社会心理治疗可以 增强对美沙酮药物疗法的反应，他们还发现有限 提供这些服务时，兴趣和出勤率不佳。 这个问题说明了对新的服务交付模型的需求 确保参与最大化所需的社会心理治疗 对药物治疗的反应。为了有效，这些新模型的 治疗也必须取得成功而不会对治疗造成伤害 保留。 Levo Alpha乙酰基美沙醇（LAAM）的批准用于阿片类药物维护 疗法提出了一个重要的问题，这一点很重要 - 是否 一种药物（即美沙酮）有效的社会心理治疗 将在其他药物治疗中保留其功效。我们以前 证明了新的治疗输送模型的有效性 阿片类药物滥用者通过制作出色的临床结果 美沙酮的持续可用性最终取决于咨询 出席和节制的简短情节。在拟议的研究中，我们 将在一组新的阿片类药物中评估这种治疗的功效 施虐者在LAAM上感应并维护，该LAAM的施用师非常不同 临床药物报告时间表可能与 行为干预措施推动了治疗方法。 总共220名患者将随机分配给我们的专业 治疗或标准护理比较组，并在10上进行了评估 一个月期，包括一个月的基准和三个月的随访。 重大结果措施包括咨询率，自我 报告并客观地衡量了毒品使用，艾滋病毒风险行为的发生率 变化和保留率。该研究还将提供信息 关于个体差异的影响（例如，精神病 发病率，个性，变化阶段）对LAAM替代的回应 当它与函示或独立地管理时 预定的咨询服务。